The overall goal of "In-Home Prevention of Substance Abuse Risks for Native Teen Families," (NIDA 5R01DA019042) and this renewal is to assess the efficacy of the "Family Spirit" (FS) intervention, a prenatal and early childhood home visiting program, delivered by American Indian (AI) paraprofessionals to AI teen mothers and their children. The FS intervention is designed to promote mother's effective parenting practices and reduce maternal and child emotional and behavioral risks for lifetime drug abuse. At the time of submission, we have recruited our entire sample (N=322), who at baseline are expectant AI teens, ages 12-19 years and <32 weeks gestation from four southwestern AI reservation communities. Participants have been randomized 1:1 to the FS Intervention + Optimized Standard Care vs. Optimized Standard Care. This renewal will allow us to assess the FS intervention until 6 years postpartum, through the critical developmental time period when teen mothers transition to adulthood and their children begin school. High rates of teen child-rearing and drug use are intertwined perpetuators of multigenerational family problems in American Indian communities. Successful prevention interventions targeting effective parenting and maternal drug use prevention with AI teen mothers can change the trajectory of young mothers'and their children's lifetime risks for drug use, and help break the cycle of multi-generational family problems in reservation communities. The goal of this renewal is to extend the assessment period until 6 years post-partum to determine the impact of the FS intervention on longer-term maternal and child outcomes related to lifetime drug use risk. The expanded and extended assessment battery will assess mothers'parenting skills and children's developmental status from birth to 6 years postpartum;mothers'drug use from <32 weeks gestation to 6 years post-partum;and explore moderators and mediators of study outcome. This trial is the first to investigate the impact of a paraprofessional-delivered, early childhood home visiting intervention on lifetime multi-generational (mother-child) drug use risk. This study addresses extremely important behavior health and illicit drug use issues among AI teen mothers and their offspring in communities located on reservation or trust lands. Demonstrating the effective use of Native paraprofessionals will be an innovation in the home-visiting intervention field, and is a critical design element to be tested in low-resource communities that suffer nursing shortages, have few trained Native interventionists, and expressed preferences for indigenous providers. PUBLIC HEALTH RELEVANCE: This study addresses critical behavioral health disparities and drug abuse among American Indian teen mothers and their children in communities located on reservation lands. If the aims are achieved, scientific knowledge and clinical practice will be advanced in several areas important to early intervention with teen mothers in this and similar populations, and to prevention of behavior problems in young children that lead to adolescent and adult drug use.